Can You Get Disability For Fibromyalgia?
Fibromyalgia is a debilitating condition that causes widespread musculoskeletal pain on both sides of the body above and below the waist. It can also cause headaches, fatigue, brain fog, anxiety, and depression. It can significantly affect your ability to stand, sit, walk, care for your needs, or perform work-related activities on a reliable basis.
- Fibromyalgia and SSDI Eligibility: Fibromyalgia can qualify you for Social Security Disability Insurance (SSDI) if it severely limits your ability to work.
- Documenting Symptoms: Consistent documentation of symptoms like widespread pain, fatigue, and cognitive issues is crucial for your SSDI application.
- Medical Evidence: Providing comprehensive medical evidence, including doctor’s reports and treatment records, strengthens your SSDI claim.
- Legal Assistance: Consider seeking help from a disability attorney to navigate the SSDI application process and increase your chances of approval.
The Social Security Administration failed to recognize fibromyalgia as a legitimate disability until 2012, when it issued a ruling that acknowledged it as a disabling condition and provided qualifying disability criteria.
You may be eligible for Social Security benefits if fibromyalgia prevents you from working. The Social Security Administration offers disability benefits through Social Security Disability Insurance, or SSDI, and Supplemental Security Income, or SSI. At Disability Advice, we help people understand the disability claims process and provide help to access the benefits they need.
Does Fibromyalgia Qualify For Disability Benefits?
Yes, you may qualify for Social Security disability benefits if your fibromyalgia prevents you from working, whether at the type of work you did before or any other job, including sedentary work. Unlike many conditions, fibromyalgia is not included in the Social Security Administration’s Listing of Impairments, also known as the Blue Book, which sets forth the requirements for a host of qualifying conditions.
However, those with unlisted conditions may also qualify for Social Security Disability benefits, although their application may undergo a more extensive review process than if the conditions were listed. In some cases, Social Security may determine that fibromyalgia is equal to a listed condition, allowing the claimant to receive approval without the extra steps.
Fibromyalgia As a Medically Determinable Impairment
On July 25, 2012, the Social Security Administration issued a Policy Interpretation Ruling on the evaluation of fibromyalgia that specifies what symptoms make it a medically determinable impairment.
The ruling defines disabling fibromyalgia as a history of widespread pain on both sides of the body above and below the waist, including persistent bone pain in the cervical spine, middle spine, lower back, and chest. The pain must have persisted for at least three months to meet the SSA’s definition. You must have at least 11 of the following 18 tender pain points:
- The base of the skull
- Back of the neck
- The sides of the neck
- The muscles of the shoulders
- The muscles near the shoulder blades
- The second rib near the breastbone
- Outer elbows
- The muscles at the top of the buttocks
- The muscles below the hips
- The inner parts of the knees
You must also have had repeated episodes of six or more symptoms common to fibromyalgia, including fatigue, unrestful sleep, depression, anxiety, irritable bowel syndrome, and brain fog. The brain fog of fibromyalgia is commonly known as “fibro fog,” and it manifests as problems with thinking and memory.
How Social Security Determines If Your Fibromyalgia Is a Qualifying Disability
To determine whether you are eligible for Social Security Disability for fibromyalgia, the Social Security Administration must determine whether you are capable of performing substantial gainful activity. Substantial gainful activity is employment with earnings higher than the limit set by the SSA. This amount changes annually based on inflation. In 2024, this maximum is $1,550.
The SSA will consider five questions, as discussed below.
1. Are You Working?
If you are working and earning more than the substantial gainful activity limit, the Social Security Administration will likely use it as evidence that you can work, determine that you are not disabled, and deny your claim. If you are not working, the administration will move to question two.
2. Is Your Condition “Severe”?
The Social Security Administration will consider your fibromyalgia a severe condition if the pain has more than a minimal effect on your ability to function, has persisted for at least three months, and is expected to affect your ability to work for at least 12 months.
According to StatPearls Publishing, fibromyalgia is a chronic condition that typically has a poor prognosis. Risk factors for a poor prognosis include:
- Obesity
- Low socioeconomic status
- High stress
- Untreated anxiety or depression
- Moderate or severe limitations
- History of abuse
- Long duration of disease
In addition, females tend to have poorer outcomes than males.
The widespread pain, cognitive effects, and mental health effects of fibromyalgia could reasonably impair your ability to work and may qualify as severe. If the administration determines your fibromyalgia is severe, the reviewer will move to question three.
3. Is Your Condition Found in the List of Disabling Conditions?
Fibromyalgia is not on the Listing of Impairments. However, the Social Security Administration will also consider whether your fibromyalgia is equal to a listed condition. For example, your symptoms may be similar enough to inflammatory arthritis to be considered an equal condition. Inflammatory arthritis is a listed condition. Thus, your disability application for fibromyalgia may receive the same treatment as one for inflammatory arthritis.
If your fibromyalgia is equal to a listed condition, the SSA will determine that you have a qualifying disability and proceed to the medical portion of your application.
If your fibromyalgia is not deemed equal to a condition on the Listing of Impairments, it doesn’t disqualify you. Instead, the reviewer must evaluate the next two questions. The evaluation of questions four and five is called the Residual Functional Capacity, or RFC, assessment.
4. Can You Do the Work You Did Previously?
Many people with fibromyalgia quit their jobs because of disabling pain, fatigue, impaired thinking, and frequent hospitalizations. They are often unable to return to their previous work. When evaluating whether you can return to your previous type of work, Social Security will consider whether you can perform it similarly to how you did before or based on how it is typically performed.
If the administration determines you can return to your previous work, it will deny your application. If it determines you cannot, it will proceed to question five.
5. Can You Do Any Type of Work?
The administration will evaluate whether you can do any type of work, including sedentary work. It must consider all of the effects of fibromyalgia and assess your ability to function. The SSA will determine whether you can be expected to adjust to other work in the national economy.
If your symptoms substantially prevent you from performing any type of work, the administration must find that you are disabled. If you are older than 55 with no past relevant work history and limited education, the administration must find you disabled if your fibromyalgia causes one or more impairments.
RFC for Fibromyalgia
The RFC assessment of questions four and five measures your maximum remaining ability to perform work activities in a normal work setting on a regular and continuing basis. The Social Security Administration defines “a regular and continuing basis” as an eight-hour workday five days a week or an equivalent schedule. However, if you have worked part-time during the last 15 years, the SSA could assess your eligibility based on the number of part-time hours you worked.
The RFC assessment includes evaluating your ability to perform sedentary, light, or medium work even if you can no longer perform activities requiring high exertion levels. The Social Security Administration performs an RFC assessment if your circumstances meet all the conditions below:
- You are not performing substantial gainful activity.
- Your medical factors alone are not enough to confirm your disability.
- Your impairment is not among those in the SSA’s Listing of Impairments or equal to a listed impairment.
Exertional and Non-Exertional Capacity
The RFC test measures functional limitations, restrictions, and capacity to perform work-related mental and physical activities over a sustained period. The Social Security Administration must consider your exertional and non-exertional capacity when determining whether your fibromyalgia constitutes a qualifying disability.
Exertional capacity measures your ability to perform tasks that require physical strength and stamina, while non-exertional capacity measures your ability to perform sedentary, mental, or light tasks. Non-exertional capacity is also a measurement of your tolerance of the work environment.
The SSA must separately evaluate your ability to perform each of the exertional and non-exertional activities in the table below to determine whether you have a disability that prevents you from working.
| Exertional Activities | Non-Exertional Activities |
|---|---|
| Sit | Changing your posture, such as bending |
| Stand | Handling objects |
| Walk | Seeing |
| Lift | Hearing |
| Carry | Speaking |
| Push | Thinking |
| Pull | Remembering |
When determining you have a qualifying disability, Social Security must connect your impairments to work limitations. For example:
- Pain and fatigue from fibromyalgia may prevent you from performing exertional activities.
- Fatigue or fibrofog can impair concentration, memory, and complex thought processes required in the workplace.
- Depression and anxiety from fibromyalgia may prevent you from tolerating work environments.
What Evidence Does Social Security Use for RFC Assessments?
The Social Security Administration relies on the following evidence to determine whether you have a qualifying disability when performing an RFC assessment:
- Medical history
- Medical test results
- Your response to medical treatment
- Reports about your daily activities
- Evidence from people who have regular contact with you
- Observations of Social Security staff
- Statements by medical providers
- How your symptoms affect you
- Results of any attempts to work since acquiring your condition
- Whether you need a structured living environment
- Work evaluations
According to the 2012 policy statement regarding fibromyalgia, the SSA acknowledges that people with fibromyalgia have good and bad days. Your good days should not work against you during an RFC assessment. Instead, the administration will consider the big picture by looking at the effects of your fibromyalgia long term.
Living with Fibromyalgia and Receiving Disability Benefits
If you have been diagnosed with fibromyalgia and the condition prevents you from working, you may be eligible for Social Security Disability Insurance, Supplemental Security Income, or both. While both of these programs provide assistance to people with disabilities, the eligibility criteria vary.
Social Security Disability Insurance
You may be eligible for Social Security Disability if you have a qualifying disability and have earned enough work credits. You can earn up to four work credits per year. When evaluating your eligibility, the SSA will look at the work credits you earned recently and the number of years you have worked in your lifetime. To earn work credits, you must pay Social Security taxes from your earnings. These taxes are typically paid by payroll deductions from your paycheck. The minimum work credits you need vary by age.
The Social Security Administration determines your monthly benefit amount based on your earnings. The maximum benefit as of 2024 is $3,822, but this amount is only available to the highest-income earners. As of May 2024, the average monthly Social Security Disability benefit was $1,537.64.
If you qualify for SSDI, you will also become eligible for Medicare 24 months after you become eligible for SSDI benefits or upon turning 65, whichever comes first. Once you turn 62, your SSDI will convert to retirement benefits, but the amount typically stays the same.
Supplemental Security Income
SSI is another form of assistance Social Security provides to people with disabilities who do not have enough work credits to qualify for SSDI. SSI’s disability criteria are the same as SSDI, except those 65 or older also qualify. To qualify financially, your income must be lower than the following:
- $1,971 per month of employment income
- $963 per month in unearned income
These limits are higher for couples, people with children, and those living in certain states. You must have assets of no more than $2,000 if you are single or $3,000 if you are married. These are 2024 numbers. The Social Security Administration offers an annual cost of living adjustment, known as a COLA, to compensate for inflation.
If you qualify for SSI, the amount you receive will depend on your income. The maximum monthly benefit in 2024 is $943. You may be able to receive SSDI and SSI if your SSDI benefit is lower than $963 per month.
Contact Us For Help Applying for Fibromyalgia Disability Benefits
SSDI claims are often wrongly denied. We can help you appeal and win money for you. We can also help with your initial application to increase your odds of being approved the first time. We are your trusted SSDI resource. Contact us today for a free consultation, and let us help you get the benefits you deserve.
- Free case evaluation
- Assist with denied claims
- Ensure you have all documents
- Make the process easy for you
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